OIG Report Highlights Personal Care’s Outsized Role In Medicaid Fraud

As at-home care has increasingly become a more popular model for health care, a significant portion of fraud convictions over the last 10 years have involved personal care services attendants. Between 2014 and 2023, personal care services accounted for at least 34% of fraud convictions in some years and as much as 48% in other […]

Home Health Agency Agrees To Pay $10 Million In Fraud Case

A home health agency has agreed to pay nearly $10 million to settle allegations that it submitted false claims to a health care program for Department of Energy workers. The Wisconsin-based Atlantic Home Health Care (AHH) is a home health care agency that operates in nine states. The U.S. government alleges that in Arizona, between […]

Cigna Reaches $172 Million Settlement Over False Claims Act Allegations

Insurance giant Cigna (NYSE: CI) has reached an agreement with the U.S. government over claims it overcharged the Medicare Advantage (MA) program by misrepresenting patients’ conditions. As part of the agreement, Cigna will pay more than $172 million to the government and will also enter into a corporate integrity agreement with the U.S. Department of […]

Jury Convicts Duo In $93 Million Medicare Home Health Fraud Scam

A man and woman in Florida were convicted for their roles in a conspiracy to defraud Medicare by billing over $93 million for home health therapy services that were never provided. The conviction was brought down by a federal jury in Miami this week. The two people convicted — Karel Felipe and Tamara Quicutis — […]

Where, When And Why Home Health Billing Fraud Becomes Obvious

A new comprehensive study is shining a light on potential factors that have led to home health billing fraud over the years. Among other findings, researchers at Dartmouth’s Geisel School of Medicine concluded that home health agencies that share patients across multiple agencies, and those that had high rates of expenditures across hospital referral regions […]

Cyber Attacks Hurt Home Health Operations – But Patient Outcomes Are Next

For home-based care providers, cyber attacks are less likely to be an “if,” and more likely to be a “when.” And, as cyber attackers get more creative and persistent, it’s important for providers to understand the implications of attacks. “Over the last 18 months, we’re seeing massive impacts to patient care,” Fortified Health Security CEO […]

DOL Will Claw Back Nearly $10 Million From Direct Care Worker Staffing Agency

The U.S. Department of Labor (DOL) announced that it will recover $9.3 million in back wages and liquidated damages. The funds stem from a Philadelphia health care staffing company misclassifying 1,756 employees, including home health aides, and depriving them of overtime wages. A consent judgment in the U.S. District Court for the Eastern District of […]

Home Health Nurse Pleads Guilty To $100M Fraud And Kickback Scheme

A home health nurse has pleaded guilty, in federal court in Boston, in relation to a $100 million home health care kickback scheme. Last week, Winnie Waruru pleaded guilty to one count of conspiracy to commit health care fraud; one count of health care fraud; one count of conspiracy to pay and receive kickbacks; two […]